SRS344 - Robot-assisted thoracic surgery versus video-assisted thoracic surgery for resection of the lung: a systematic review and meta-analysis

Abstract Introduction Lung resection, the surgical removal of part of the lung, is used to treat conditions such as lung cancer, benign tumors, and infections. Video-assisted thoracoscopic surgery (VATS) is a common minimally invasive approach, but advances in robotics have introduced robot-assisted thoracoscopic surgery (RATS), which may offer greater efficacy and safety. This study compares VATS and RATS to determine which provides superior clinical outcomes for lung resection. Methods A comprehensive search was conducted in PubMed, ClinicalTrials.gov, and Cochrane Library from inception to June 2025, following PRISMA guidelines. Primary outcomes included Lymph Node Yield and Operative Time. Secondary outcomes included R0 resection rates, post-op complication rates and recurrence rates. Data was analyzed using Review Manager v5.4.1, with random-effects models employed for all outcomes. Results Twenty-nine studies, comprising 66 406 patients, were included. RATS significantly improved the Lymph Node Yield (MD 4.54, 95% c.i. 2.91, 6.17). It also improved operative time (MD −6.09, 95% c.i. −13.20, 1.03), albeit the overall effect was insignificant. RATS significantly improved the odds of R0 resections (OR 1.23, 95% c.i. 1.02, 1.48), while decreasing the risk of post-op complications (RR 0.86, 95% c.i. 0.75, 0.99) and recurrence (RR 0.69, 95% c.i. 0.48, 1.00). Conclusions RATS significantly improve surgical outcomes as well as post operative outcomes for patients of lung cancer, as compared to VATS. With advancements in robotics, making them more accessible and feasible, their clinical efficacy and safety makes RATS a contender to be the gold standard for lung resections.